title: Eighteen cases of crowned dens syndrome: Presentation and diagnosis.
abstract: OBJECTIVE
  Crowned dens syndrome is an ill-known etiology of acute neck pain.
  
  
  METHODS
  We carried out a retrospective study of 18 cases of patients with crowned dens syndrome, assessing clinical and radiological features.
  
  
  RESULTS
  The results of our study are comparable to data from the literature. The clinical presentation of acute febrile neck pain, occipital headache and multidirectional stiff neck especially affects women aged over 60. No predisposing factor was recognized. However, a history of peripheral joint chondrocalcinosis may reinforce the diagnosis. In more than 50% of cases, laboratory tests showed a marked inflammatory syndrome. The diagnosis was obtained with cervical CT-scan focusing on the C1/C2 joint. This gold standard test was able to show a calcification of the cruciform ligament in connection with deposits of calcium pyrophosphate crystals in almost 80% of cases. Other imaging tests provided little information, including standard radiographs of the cervical spine. MRI can eliminate some differential diagnoses such as infections or neurological emergencies. Complications are infrequent. The standard treatment is based on anti-inflammatory drugs (NSAID, colchicine) or corticosteroids. These treatments are highly effective: a drammatic full recovery of cervical mobility may be observed within 48 hours. In over half of cases, a different diagnosis was initially made, responsible of unnecessary additional tests and treatment.
  
  
  CONCLUSIONS
  A comprehensive consultation, a complete clinical examination and a precise analysis of the imaging will avoid certain investigations and rule out differential diagnoses.
authors.affiliation: Service de rhumatologie, CHU Jean-Minjoz, boulevard Fleming, 25030 Besançon cedex, France. m1valnet@chu-besancon.fr
authors.forename: M
authors.initials: M
authors.lastname: Godfrin-Valnet
authors.forename: G
authors.initials: G
authors.lastname: Godfrin
authors.forename: J
authors.initials: J
authors.lastname: Godard
authors.forename: C
authors.initials: C
authors.lastname: Prati
authors.forename: E
authors.initials: E
authors.lastname: Toussirot
authors.forename: F
authors.initials: F
authors.lastname: Michel
authors.forename: D
authors.initials: D
authors.lastname: Wendling
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000368:Aged; D000369:Aged, 80 and over; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D001268:Atlanto-Axial Joint / Q000473:pathology*; D002131:Calcium Pyrophosphate / Q000378:metabolism; D002805:Chondrocalcinosis / Q000150:complications / Q000188:drug therapy / Q000473:pathology; D003078:Colchicine / Q000627:therapeutic use; D005260:Female; D006074:Gout Suppressants / Q000627:therapeutic use; D006261:Headache / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D019547:Neck Pain / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy*; D009809:Odontoid Process / Q000473:pathology; D013131:Spine / Q000473:pathology; D014057:Tomography, X-Ray Computed
chemical_list: D000305:Adrenal Cortex Hormones; D000894:Anti-Inflammatory Agents, Non-Steroidal; D006074:Gout Suppressants; D003078:Colchicine; D002131:Calcium Pyrophosphate
keywords: Acute neck pain; Articulation axis-atlas; Atlanto-axial joint; Cervical CT-scan; Cervicalgies; Chondrocalcinose; Chondrocalcinosis; Scanner cervical